Effect of Evodia rutaecarpa plus oseltamivir in regulating body temperature and inflammatory cytokines in infants and young children with viral fever

Abstract: Background: viral fever is a common acute infectious disease among infants and young children. Oseltamivir, a first-line antiviral drug, has limitations in inflammation regulation. In contrast, Evodia Rutaecarpa (E. Rutaecarpa) has been proven to exert antipyretic effects in traditional Chinese medicine. Objectives: This study, for the first time, systematically evaluated the efficacy of topical E. Rutaecarpa acupoint preparation plus Oseltamivir in treating viral fever in infants and young children. Methods: In this retrospective analysis, we included 60 pediatric cases between the ages of 6 months and 3 years and assigned them 1:1 according to propensity score matching (PSM): a combined group (topical E. Rutaecarpa acupoint application + oral Oseltamivir) and a control group (oral Oseltamivir alone). The treatment course lasted for 5 days. The main outcome measure was antipyretic time and the secondary outcome measures included changes in body temperature at different time points, serum inflammatory factors (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6], interleukin-1β [IL-1β], high-sensitivity C-reactive protein [hs-CRP]) levels, treatment comfort score (TCS), sleep quality index (SQI), adverse reactions and parents' satisfaction. Results: The antipyretic time was found to be shorter in the combined group than in the control group. Besides, the combined therapy led to markedly milder body temperature fluctuations at 24 hours and 48 hours, as well as greater decreases in serum inflammatory markers (tumor necrosis factor-α [TNF-α] and interleukin-6 [IL-6]), compared to Oseltamivir monotherapy. Additionally, improved TCS and PSQI scores were found in pediatric patients receiving E. Rutaecarpa + Oseltamivir, together with superior parental satisfaction (P<0.01). The two groups showed no notable difference in the incidence of adverse reactions, with no added burden on liver and kidney functions with the combination therapy. Conclusion: Topical E. Rutaecarpa preparation exerts a three-dimensional effect of "acupoint stimulation‒transdermal drug delivery‒systemic anti-inflammation", synergizing with oral Oseltamivir. This combined therapy demonstrates greater advantages in rapidly reducing fever, regulating inflammation and improving patient comfort.